Low-dose oral or non-oral hormone therapy: effects on C-reactive protein and atrial natriuretic peptide in menopause

Abstract

Objective To assess the effects of oral low-dose and non-oral hormone therapy (HT) on ultra-sensitive C-reactive protein (CRP), atrial natriuretic peptide (ANP), and cardiovascular risk factors in postmenopause.

Methods In this randomized, cross-over study, 44 recently postmenopausal women, with no clinical evidence of cardiovascular disease, received oral low-dose HT (estradiol 1 mg + drospirenone 2 mg/day) for 3 months. Forty-two patients received non-oral, conventional HT (1.5 mg/day percutaneous 17β-estradiol gel or equivalent for nasal route) for 3 months followed by 200 mg/day micronized progesterone by the vaginal route (14 days during each menstrual period). After 3 months, patients were crossed over without washout. Post-HT vs. pre-HT measures were determined: lipids, glucose, body mass index, waist circumference, fibrinogen, CRP-stratified levels, and ANP levels. The study was registered at clinical trials.gov (NCT01432028).

Results The mean age was 51 ± 3 years and the mean time since the menopause was 22 ± 10 months. CRP-stratified high levels decreased in a higher number of non-oral HT patients, who moved to intermediate and low levels (p = 0.02). No effect of HT was observed on ANP levels (baseline 67.4 (18.4–104.5), low-dose oral 43.5 (14.4–95.9), non-oral 39.8 (15.5–67.5) pg/ml). Markers of endothelial function did not worsen with either low-dose oral or non-oral HT: von Willebrand factor (baseline 118 ± 37%, low-dose oral 119 ± 38%, non-oral 108 ± 3%, p < 0.01), fibrinogen (baseline 356 ± 58 mg/dl; low-dose oral 343 ± 77 mg/dl; non-oral 326 ± 71 mg/dl, p < 0.01).

Conclusions Low-dose oral and non-oral HT for 6 months had neutral or beneficial effects in recently postmenopausal women with no clinical evidence of cardiovascular disease.

Key words::

• MENOPAUSE
• CARDIOVASCULAR RISK
• HORMONE THERAPY
• ATRIAL NATRIURETIC PEPTIDE
• C-REACTIVE PROTEIN
• RANDOMIZED CLINICAL TRIAL

ACKNOWLEDGEMENT

We thank Luiz Antonio Cassio dos Santos for his support in determining atrial natriuretic peptide levels.

Conflict of interest The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the paper.

Source of funding This work was supported by grants from the Brazilian National Institute of Hormones and Women's Health, Conselho Nacional de Desenvolvimento Científico e Tecnológico [CNPq INCT 573747/2008-3], Porto Alegre, Brazil.

Supplementary material available online

Supplementary Table 1 to be found at http://informahealthcare.com/doi/abs/10.3109/13697137.2014.940309.